74-year-old patient presenting with severe shoulder dysfunction, weakness, and limited active range of motion. Clinical history likely suggests chronic pathology. Further details not provided.
Ultrasound examination of the shoulder demonstrates extensive rotator cuff pathology.
There is a complete rupture of the supraspinatus tendon, with absence of normal tendon continuity. The corresponding supraspinatus muscle shows marked atrophy and fatty infiltration, indicating chronicity.
The subscapularis tendon demonstrates a moderate to severe full-thickness tear involving part of the tendon width (partial-width), localized to the proximal portion.
There is also a complete rupture of the long head of the biceps tendon, which is no longer visualized within the bicipital groove.
The infraspinatus tendon appears intact; however, the infraspinatus muscle demonstrates significant atrophy and fatty infiltration. In the absence of a tendon tear or clear traumatic muscle injury, this raises suspicion for suprascapular nerve neuropathy as an underlying cause.
Overall, these findings are consistent with a massive rotator cuff tear with advanced chronic degenerative changes.
1. Final diagnosis
Massive rotator cuff tear consisting of a complete supraspinatus rupture, partial-width full-thickness tear of the proximal subscapularis tendon, and complete rupture of the long head of the biceps tendon, with advanced muscle atrophy and fatty infiltration. Associated suspected suprascapular neuropathy affecting the infraspinatus muscle.
2. Differential diagnosis
For isolated infraspinatus atrophy with intact tendon, consider suprascapular neuropathy versus disuse atrophy. Chronic massive rotator cuff tear may also lead to secondary muscle degeneration. MRI and/or EMG may help confirm nerve involvement.
3. Teaching points
The combination of multiple tendon ruptures and muscle atrophy defines a massive rotator cuff tear and often indicates chronic disease. Fatty infiltration is a key prognostic factor and may limit surgical repair options. Isolated muscle atrophy with intact tendon should raise suspicion for neuropathy rather than tendon pathology.
4. Injury/disease information
Massive rotator cuff tears typically develop over time due to chronic degeneration and may involve multiple tendons. The long head of the biceps is frequently involved. Chronic tears can lead to muscle atrophy and fatty infiltration, reducing function and complicating treatment. Suprascapular nerve neuropathy can result in selective muscle atrophy, particularly affecting the infraspinatus.
Marc is founder of, and trainer at, SonoSkills. SonoSkills is an organization dedicated to MSK ultrasound education. He's also an MSK Sonographer at the Laurentius Hospital in Roermond, the Netherlands.
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